A Practical Guide to Medicare Appeals describes the steps necessary to successfully resolve appeals of all types of Medicare determinations. Co-authored by a CMS hearing officer and a private practitioner with years of Medicare appeals experience, this book will walk practitioners through every step of the very confusing and sometimes self-contradictory rules so that appeals can be decided on their merits rather than barred for procedural rules violations.

Anyone who submits Medicare claims and receives Medicare reimbursements needsto be fully prepared to follow the appeals process when claims are rejectedand/or refunds are requested.Medicare Claims Appeals Process Handbook helps you understand - and explain -the process every step of the way. You'll know exactly what you can and can'tdo, the essential timeframes for pursuing appeals, where to send information,and how to proceed - at every level of the appeals process!The Medicare Claims Appeals Process Handbook will help you:Increase yourlikelihood of success in the claims appeal by lowering the possibility ofprocedural error and avoiding costly errorsNavigate all four levels of the administrative appeal processProceed to federal court if necessaryStay current with changing rules, regulations, and proceduresPut best practices in place - immediately!Only Medicare Claims Appeals Process Handbook includes letters, forms, charts,and more - all designed to provide you with practical support throughout theprocess.Medicare Claims Appeals Process Handbook has been updated to include:Expanded material on electronic claims submissionA sample denial of an "unusual circumstance" waiver requestInformation on medical necessity denialsA new National Coverage Analysis (NCA) tracking sheet and proposed decisionmemo for MRIsUpdated Medicare redetermination request formsRequest for review of Administration Law Judge (ALJ) Medicaredecision/dismissalComparison of standard and expedited appeals processesUpdated CMS appointment of representative formNew material on the role of the Medicare administrative contractorA sample Medicare Summary NoticeImportant information on overpayment and suspension of paymentsRecent case law regarding exhaustion of administrative remediesUpdated material on good cause for reopening

"This book is about how to successfully fight for the payment of medically reasonable and necessary services when Medicare erroneously denies payment, or when Medicare erroneously demands a repayment of overpayment"--

Did you know the time for your healthcare provider's Medicare hearing has skyrocketed from the Congressionally mandated three months to over three years? Did you want to know why the good ship OMHA has been swamped? Did you know the crisis affects all of us, and that we must act now before the 2016 budget is passed? Would it surprise you that the bill pending in Congress to address the backlog of over 600,000 cases - the AFIRM (Audit & Appeal Fairness, Integrity and Reforms in Medicare Act) is not a panacea? Do you want straight talk from a former ALJ about what's going on at Medicare (CMS) and in the Office of the Chief Judge? Can you imagine a system that works for us, not for ""them?"" A portion of the proceeds are donated to worthy causes, such as the Center for Medicare Advocacy. Note: You can buy a book without setting up a Lulu account. Thank you.